A patient has been admitted to the coronary care unit (CCU) with an ST-segment-elevation myocardial infarction (STEMI). The patient is restless, anxious, has a blood pressure of 86/40 mm Hg, and a heart rate of 132 beats/min.
What is the priority problem for this patient?
Anxiety
Acute pain
Decreased cardiac output
Stress management
The Correct Answer is C
Choice A rationale
Anxiety is a common response to the stress of hospitalization and illness, especially in the context of a serious condition like ST-segment-elevation myocardial infarction (STEMI).
However, while anxiety can exacerbate physical symptoms and should be addressed, it is not the primary problem in this scenario.
Choice B rationale
Acute pain is a common symptom of STEMI, as the heart muscle is deprived of oxygen. However, the patient’s blood pressure and heart rate readings suggest a more immediate concern related to the cardiovascular system.
Choice C rationale
Decreased cardiac output is likely the priority problem for this patient. The patient’s low blood pressure (86/40 mm Hg) and high heart rate (132 beats/min) suggest that the heart is not pumping enough blood to meet the body’s needs, which is a direct consequence of the STEMI1. This can lead to organ failure and other serious complications if not addressed promptly.
Choice D rationale
Stress management is an important aspect of long-term care for patients with heart disease, as chronic stress can contribute to further heart damage. However, in the acute phase of a STEMI, the focus is on stabilizing the patient’s condition and preventing complications.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Smoking cigarettes can exacerbate the symptoms of Raynaud’s disease by causing further constriction of the blood vessels. Therefore, a patient who continues to smoke cigarettes may need further education about the management of Raynaud’s disease.
Choice B rationale
Eating bananas twice a day is not typically a concern for patients with Raynaud’s disease.
Choice C rationale
Wearing mittens outside, especially in cold weather, is a recommended strategy for managing Raynaud’s disease. It can help to prevent episodes of Raynaud’s by keeping the hands warm and reducing exposure to cold temperatures.
Choice D rationale
Taking calcium channel blockers is a common treatment for Raynaud’s disease. These medications help to relax and open up the small blood vessels in the hands and feet, reducing the severity and frequency of Raynaud’s episodes.
Correct Answer is D
No explanation
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